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首页> 外文期刊>Neurosurgery >Supracerebellar-supratrochlear and infratentorial-infratrochlear approaches: gravity-dependent variations of the lateral approach over the cerebellum.
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Supracerebellar-supratrochlear and infratentorial-infratrochlear approaches: gravity-dependent variations of the lateral approach over the cerebellum.

机译：小脑上bell上和腓肠肌下approaches上入路：小脑外侧入路的重力依赖性变化。

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OBJECTIVE: Lateral supracerebellar-infratentorial approaches are established for lesions in ambient cistern and posterolateral midbrain, but published surgical experiences do not describe results with this approach in the sitting position. Gravity retraction of the cerebellum opens this surgical corridor and dramatically alters exposure, creating 2 variations of the lateral supracerebellar-infratentorial approach: the supracerebellar-supratrochlear approach and the infratentorial-infratrochlear approach. METHODS: We reviewed our experience treating cavernous malformations and arteriovenous malformations (AVMs) of the posteroinferior thalamus and posterolateral midbrain by use of supracerebellar-supratrochlear and infratentorial-infratrochlear approaches. Microsurgical technique, clinical data, radiographic features, and neurological outcomes were evaluated. RESULTS: During an 11-year surgical experience with 341 cavernous malformation patients and 402 AVM patients, 8 patients were identified, 6 with cavernous malformations and 2 with AVMs. Infratentorial-infratrochlear approaches were used in 4 patients (50%), including 3 with inferolateral midbrain cavernous malformations. Supracerebellar-supratrochlear approaches were used in 4 patients (50%), including 2 with posterior thalamic lesions surfacing on pulvinar. Resections were radiographically complete in all cases. There were no new, permanent neurological deficits, nor were there any medical or surgical complications. There has been no evidence of rebleeding or recurrence. CONCLUSIONS: Gravity retraction of the cerebellum transforms the lateral supracerebellar-infratentorial approach, enhancing exposure and approach trajectories that can be achieved with patients in prone or lateral positions. The increased upward viewing angle of the supracerebellar-supratrochlear approach accesses the posteroinferior thalamus. The increased downward-viewing angle of the infratentorial-infratrochlear approach accesses cerebellomesencephalic fissure and posterolateral midbrain. These approaches open wide corridors for safe surgical resection of symptomatic cavernous malformations and AVMs.
机译：目的：为周围水箱和后外侧中脑的病变建立外侧上小脑-腓肠肌入路，但已发表的外科手术经验并未描述这种坐位方法的结果。小脑的重力牵开打开了这个手术通道，并显着改变了暴露，创造了外侧上小脑-腓肠肌入路的两种变化：上小脑-上rat肌入路和下-小脑室下入路。方法：我们回顾了我们的经验，通过使用上小脑-上上睑下支和下-下-腓肠肌方法治疗后下丘脑和后外侧中脑的海绵状畸形和动静脉畸形（AVM）。显微手术技术，临床数据，影像学特征和神经系统的结果进行了评估。结果：在11年的手术经验中，有341例海绵状畸形患者和402例AVM患者，确定了8例患者，其中6例为海绵状畸形，2例为AVM。 4例（50％）患者采用了下颌下肌入路，其中3例患有下外侧中脑海绵状畸形。 4例（50％）患者使用了上颅上-上睑上睑入路，其中2例丘脑后部病变位于鼓膜上。在所有情况下，切除均在放射学上完成。没有新的永久性神经功能缺损，也没有任何医学或手术并发症。没有证据表明再出血或复发。结论：重力牵引小脑改变了外侧小脑-腓肠肌下入路，增强了俯卧或侧卧患者所能达到的暴露和入路轨迹。上小脑-上上睑入路的向上增加的视角进入后下丘脑。从下到下室静脉入路的向下增加的视角可进入小脑中脑裂孔和后外侧中脑。这些方法为有症状的海绵状畸形和AVM安全手术切除开辟了广阔的走廊。

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